title: Cost and quality of life in patients with severe chronic hand eczema refractory to standard therapy with topical potent corticosteroids.
abstract: BACKGROUND
  Little is known about the socio-economic burden of severe chronic hand eczema in patients refractory to treatment with potent corticosteroids.
  
  
  OBJECTIVE
  To estimate the socio-economic burden of severe chronic hand eczema refractory to potent topical corticosteroids, and to establish an algorithm for the estimation of the health-related quality of life EuroQol five-dimensional (EQ-5D) utility index from the Dermatology Life Quality Index (DLQI) summary score.
  
  
  METHODS
  A multicentre cost of illness study was conducted, adopting the societal perspective. Adult patients with severe and refractory chronic hand eczema were enrolled. Direct (e.g. drug treatment and travel) and indirect (i.e. loss of productivity) mean costs/patient-month were estimated. Health-related quality of life was assessed with the EQ-5D and DLQI questionnaires. An ordinary least square regression model was used to investigate relationships between health-related quality of life scores.
  
  
  RESULTS
  One hundred and four valid patients (mean age 44.5 years, 39.4% male) participated. Overall mean costs were €418.3/patient-month: loss of productivity contributed 43.7%, followed by hospitalization (16.1%) and travel (10.3%). Health-related quality of life scores were, on average, 0.50 (EQ-5D utility) and 11.3 (DLQI). Utility and DLQI summary were significantly related to each other.
  
  
  CONCLUSIONS
  Wellbeing and loss of productivity are the most important consequences in these patients. Appropriate treatment is necessary to improve patient health and productivity, which will contribute to reducing societal costs.
authors.affiliation: Research Centre on Public Health (CESP), University of Milan-Bicocca, 20052, Monza, Italy; CHARTA Foundation, 20122 Milano, Italy.
authors.forename: Paolo A
authors.initials: PA
authors.lastname: Cortesi
authors.forename: Luciana
authors.initials: L
authors.lastname: Scalone
authors.forename: Andrea
authors.initials: A
authors.lastname: Belisari
authors.forename: Domenico
authors.initials: D
authors.lastname: Bonamonte
authors.forename: Serafinella Patrizia
authors.initials: SP
authors.lastname: Cannavò
authors.forename: Antonio
authors.initials: A
authors.lastname: Cristaudo
authors.forename: Ornella
authors.initials: O
authors.lastname: De Pità
authors.forename: Rosella
authors.initials: R
authors.lastname: Gallo
authors.forename: Alberto
authors.initials: A
authors.lastname: Giannetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Gola
authors.forename: Paolo D
authors.initials: PD
authors.lastname: Pigatto
authors.forename: Lorenzo G
authors.initials: LG
authors.lastname: Mantovani
mesh_terms: D000041:Absenteeism; D000203:Activities of Daily Living; D000279:Administration, Cutaneous; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D017281:Cost of Illness; D004180:Direct Service Costs; D004485:Eczema / Q000188:drug therapy* / Q000191:economics*; D004526:Efficiency; D005260:Female; D006229:Hand Dermatoses / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones
keywords: chronic hand eczema; cost of illness; health-related quality of life; healthcare costs; loss of productivity; refractoriness to therapy